Benign Prostatic Hyperplasia (BPH)

What is the prostate gland?

The prostate gland is a walnut-sized organ found in men between the penis and the bladder, in front of the rectum. The prostate gland produces the seminal fluid which serves as nourishment and protection of the sperm cells. During ejaculation, the prostate gland expels seminal fluid with the sperm.

What is BPH?

Prostate enlargement or benign prostatic hyperplasia (BPH) often occurs in aging men. Since the passageway of the urine (urethra) is found in the middle of the prostate, enlargement of the gland causes obstruction in the flow of urine. BPH causes uncomfortable urinary symptoms and may be associated with problems in the bladder, urinary tract or kidneys.

What are the signs and symptoms of BPH?

The signs and symptoms of BPH vary among men, with the size of the prostate gland not necessarily correlating with the severity of the condition.

The most common signs and symptoms of BPH include:

• Straining or difficulty starting urination
• Poor urine stream
• Intermittent urine stream (stops and starts)
• Frequent urination
• Increased frequency of urination at night (nocturia)
• Dribbling after urination
• Incomplete bladder emptying
• Urgent need to urinate

Other less common signs and symptoms include:

• Urinary tract infection (UTI)
• Inability to urinate
• Blood in the urine (hematuria)

In most men, the prostate gland continues its growth. BPH may be due to the imbalance in male hormones as men age. The risk for BPH increases from age 40 years old onwards.

Patients with a father or brother with BPH have higher risk for BPH. Other risk factors include obesity, erectile dysfunction, diabetes, heart disease, and the intake of beta blockers.

How is BPH diagnosed?

BPH is diagnosed based on the symptoms of the patient, and the findings after the digital rectal examination (DRE) to determine the size of the prostate. Analysis of the urine (urinalysis) is conducted to screen for UTI and hematuria. In select patients, physicians may request for serum prostate-specific antigen (PSA), a blood marker. Other tests include: urinary flow test, post-void residual volume test, and 24-hour voiding diary.

Additional examinations for complicated cases and/or to rule out other conditions include: transrectal ultrasound, prostate biopsy, urodynamic and pressure flow studies, and cystoscopy (insertion of a scope to visualize the urethra and bladder).

How is BPH treated?

Treatment for BPH depends on the severity of the condition, age of the patient, size of the prostate, and accompanying medical conditions.

Medications for mild to moderate BPH include:

• Alpha blockers* (e.g., silodosin, alfuzosin, tamsulosin, doxazosin, terazosin) - relax the smooth muscles of the prostate and bladder and improve urination
• 5-alpha reductase inhibitors (5-ARIs) (e.g., dutasteride, finasteride) - block the production of excessive testosterone to minimize enlargement of the prostate
• Anticholinergic agents (e.g., fesoterodine, oxybutynin, solifenacin, tolerodine) - decrease bladder contractions
• Combination therapy – alpha blocker plus 5-ARI or anticholinergic agent
• Phosphodiesterase inhibitor (PDEI) (i.e., Tadalafil) – used to treat erectile dysfunction and may be used in BPH to relax the smooth muscles of the prostate and bladder

Patients with moderate to severe BPH may need to undergo:

• Minimally invasive therapies such as transurethral needle ablation (TUNA) and transurethral microwave thermotherapy (TUMT)
• Surgical therapies such as transurethral resection of the prostate (TURP), laser, open prostatectomy, etc.

*Patients taking alpha blockers should inform their physicians if they plan to undergo cataract surgery.

What is the prognosis of a patient with BPH?

BPH may affect the quality of life of patients. The symptoms typically worsen with age in most men. However, symptoms may improve and the condition may stabilize with the proper intake of medications.

Most men do not develop complications such as urinary retention, frequent UTIs, bladder stones, and bladder and/or kidney damage. If these occur, more invasive surgeries may be advised.

How can BPH and its symptoms be prevented?

BPH is not believed to be associated with increased risk for prostate cancer.

• Lose weight
• Decrease fluid intake before going to bed
• Avoid alcohol, caffeine, and highly seasoned food
• Do not take medications without the advice of a physician as some may aggravate the symptoms of BPH (e.g., antihistamines and decongestants), and may interact with the prescribed BPH medications
• Perform exercises to strengthen the pelvic floor muscles
• Avoid delaying urination once there is an urge

For more information on BPH, consult your physician.